Mental Health Screening in HIV: Guideline and Commentary

Francine Cournos, MD


June 12, 2013

In This Article

Assessments and Screenings

Assessment for Depression, Anxiety, and PTSD

A brief screening tool, such as the Patient Health Questionnaire (PHQ-2), may be used for routine depression screening. Annual mental health screening for depression, anxiety, and PTSD can be performed with the Substance Abuse/Mental Illness Symptoms Screener (SAMISS) questionnaire,[2] which is a comprehensive mental health screening tool that has been validated in HIV-infected patients. A positive screen from these tools should prompt further evaluation by a member of the healthcare team and, if necessary, referral to a mental health provider.

For the PHQ-2 and other screening tools, see Mental Health Screening Tools. For questions from the SAMISS questionnaire that can be used for annual assessment, see the Mental Health Screening Quick Reference Guide.

Assessment of Cognitive Function

Early motor and cognitive slowing may be detected with the International HIV Dementia Scale, which can be administered by nonneurologists and has been validated in HIV-infected patients.[3] To access the International HIV Dementia Scale, refer to Mental Health Screening Tools.

Assessment of Sleep and Appetite

Sleep and appetite are important elements of a mental health assessment. Insomnia occurs frequently in HIV-infected patients and during all stages of HIV disease,[4] and weight loss is a strong predictor of HIV disease progression.[5] Resources for sleep and appetite include:

Substance Use Screening

A positive screen from any one of the following tools indicates the need for additional evaluation for substance use disorders:

  • Single Alcohol Screening Question;

  • The Two-Item Conjoint Screen (TICS); or

  • CAGE-AID (CAGE-Adapted to Include Drugs).

For these and other available tools, see the Substance Use Screening Quick Reference Guide. For additional information on substance use screening, see Screening and Ongoing Assessment for Substance Use.

Screening for and Management of Acute Suicidal or Violent Ideation or Behavior

The following algorithm can be used in the HIV primary care setting to screen for the risk for acute suicidal or violent ideation or behavior.


Algorithm for screening for the risk for acute suicidal or violent ideation or behavior.

Considerations for Mental Health Referral

Successful mental health referral involves communication between medical and mental health providers, as well as patient education. Referral to a mental health provider is warranted when a patient presents with:

  • Risk for violence to self or others;

  • Psychosis, including delusions, hallucinations, flight of ideas, and disordered thinking;

  • Poor response or relapse of psychiatric symptoms while receiving medication/treatment; or

  • Active substance abuse or relapse to substance use with mental health disorder.*

*Refer to a program for dually diagnosed patients.